My Big Fat Over Fifty Pregnancy

Ready Already!

"Are you ready to have these babies?" D asked me the other night as we headed towards the 36th week.

Contractions were coming about every 20 minutes and I thought maybe - just maybe - we were on our way.  "Yes," I told him.  "I am so ready."  I love the idea of meeting our new babies, hugging them, feeling their kicks on the outside instead of the inside.  I love the idea of not having to lie on a table twice a week listening to the doppler-amplified sound of stampedes of horses.  I am ready - so, so ready.

Except that we didn't yet have the carseats to bring the babies home and the cribs are in boxes in the garage, unassembled. "No biggie," I figured, "we can borrow carseats and put the cribs together last minute."  I'm still shifting things around in the house.  And there are still some projects I'd like to finish for clients - and some potential new clients to talk to while I am not totally sleep-deprived and have no screaming infants providing background noise.  Are you ever really ready for the grand event?

I went to sleep that night and the contractions stopped.  False labor.  Ha!  Can't fool me!  I've been through this before - three times in fact.  But that bout of contractions was not for nought.  It drove the babies deeper into my pelvis.  When I woke up that morning, my gait had become stilted.

Suddenly I can breathe without my asthma inhalers and my appetite has returned, although I don't know if that's good or bad.  All the little annoyances that came from two babies being wedged between my diaphragm, lungs and stomach have disappeared - to be replaced by new ones as they dropped lower and lower.

Our hospital bags are now packed and I've found myself hedging when people try to make plans with me.  I just don't know whether our lives will miraculously speed up, drag on or whether a medical event could summon us to the hospital immediately.  It's a strange state of limbo.  Yes, there is plenty to do - and no moss is growing under my feet.  Today the movers shifted furniture around our home. Tomorrow the new refrigerator arrives.  I have a to-do list of things I want to accomplish before I am tied to the house with two babies, hesitating to drag them out before we've established feeding, napping and other routines.  Now is the time to fix things up, stockpile necessities that are hard to aquire, and complete the tasks I've begun.

So am I ready?  The answer is yes - and no.  Maybe not quite yet.

Parenting...Again...

Confession:  I have a few "guilty pleasures."  I am not a couch potato TV watcher. But I like watching Glee, and sometimes The Bachelor, and when I get a chance I like to bury myself in crime novels.  And the computer--sometimes I find entire mornings wasted on grabbing the latest gossip from the Internet tabloids, or Facebook.  Are these pursuits worthy, healthy or good for me?  Not really.  There are so many more productive ways I can think of to spend my time--writing, cooking, baking, immersing myself in prayer, listening to Torah lectures that will help me grow in spirit, or simply taking a walk on a nice day or evening.

So as I set out to parent again, I think about the children I plan to raise, steeped in Torah values, removed and protected from the insipid influences of our secular society.  Modern values force children into growing up way too fast, present them with role models that are disrespectful and frequently vulgar, and cause them to develop habits that sometimes they never lose. I don't want my children exposed to that.  So why am I exposing my mind to that? Especially now, when I know firsthand,  that, "Do as I say, not as I do," is the worst possible caveat for raising children.

So what am I to do about the television set that I rarely watch but enjoy every so often?  Or the James Patterson books filled with suspense and and excitement?  Or the computer that sometimes takes me to cyber-playgrounds that do nothing but waste precious time on mindless drivel?  How do I give up these guilty pleasures?  I know that I have to, if I'm going to raise my children in a "bubble" to keep them happy, secure and safe--and growing strong with just the right spiritual influences.

Until now, I've blasted my ipod, with its collection of Jewish music, perched on my belly so the babies inside me didn't hear the dulcet tones of Bachelorettes trying their best to seduce The Bachelor on that mindless TV show.  But I know it's not distractions that I need to work on, rather it's my inclinations - and it has to start somewhere - and it has to start now.

Because even though these babies are inside me, they are already learning and listening.  They hear me make blessings before and after I eat - and hence, are learning that Hebrew words always accompany their food. They listen to the respectful and loving tones in our household and the laughter, no harsh words.  Their bodies have been fed only kosher foods and they are already familiar with the songs and psalms they hear each day when I pray.  Yes, the babies are learning now, but when they emerge, they will be learning even more.  They will be in constant states of observing and patterning themselves after us.  It's a responsibility that I take very seriously.  Of course, there will be house rules, but there can be no hypocricy.  Rules have to apply to all.  To our children, to everyone that surrounds us and enters our home, but most importantly, to their role models - their parents.

So I guess Rachel will have to take her beautiful voice to stardom without me knowing about it, and Kurt and Blaine will resolve their lives somehow.  And Bachelor after Bachelor will test-drive twenty-five women and titillate the rest of the USA.  And James Patterson will receive one less royalty from my pocketbook. They are no longer welcome in my home.  It may be challenging, and it's a lofty goal, but my children are worth more than all the guilty pleasures in the world.

Deus ex Medica

I was 37 weeks and counting as I sat in my doctor's office, draped in a sheet.  He walked in with his computer in hand and without looking up said, "So next week is 38 weeks...when would you like to be induced?"

Maybe somewhere this is a normal question - or maybe women sitting draped in paper sheets are too intimidated to ask a few questions themselves, but being the New Yorker I am, I found myself blurting out, "Why would I want to be induced?"

The doctor finally looked up from his electronic medical records, puzzled.  "I didn't realize you were going to be contentious," he said.

"I didn't mean to be contentious," I replied.  "After all, we are all on the same team and I think we all want the same thing - healthy babies and a healthy me.  I just wondered if there is a good REASON for your wanting to induce me.  Is my blood pressure too high?  Am I spilling protein or sugar in my urine?  Are the babies in distress?"

He wrinkled his brow.  It was clear that he was unaccustomed to being challenged when he offered up an induction date.  Maybe some women preferred to try and control when their babies would be born, or perhaps they were intimidated by the suggestion and assumed that the point wasn't open for discussion.  But it appeared to me that even if I was induced, I had no guarantee that the birth would be simple or timely, and if there is one thing this pregnancy has taught me, it's that the process of pregnancy and childbirth is not something we mortals can, or even should control.

"It's just that as you get farther along, the chances of something going wrong are greater, so we tend to induce moms of twins when they are 38 weeks along.  We've come this far and everything has been good.  We don't want to lose that momentum."

Now it was MY turn to wrinkle my brow.  Something wasn't making sense to me.

"How would you induce me?" I asked, wanting to understand his game plan.

"We would give you a Pitocyn drip and then strip the membranes," he explained.

"Correct me if I'm wrong, but aren't women who are given Pitocyn at increased risk for a C-section?" I asked.  Before he could answer, I got another question in, "And once you stripped the membranes, wouldn't the clock be ticking - and it is my understanding that stripping the membranes only works when a woman has begun labor - so wouldn't that mean if I haven't entered active labor at some point, you would possibly have to section me?"

I handed him an article, written by an OB/GYN that substantiated this claim.  I just happened to have it bookmarking my James Patterson novel.

"Well, yes," he phumphered, skimming through the article, "but we don't expect that to happen."

He gave me a dazzling smile.  "What if we agreed to compromise," he said.  "We induce at 39 weeks?"

I returned the smile but didn't say anything.

"39 weeks and 4 days?" he continued.

"We could do something really radical," I said.  "We could let my body and my babies decide when they are ready to come out.   We could continue to monitor me with the NST's and Biophysical Profiles - just so we can keep a close eye on the babies, the placenta and all the things that could go wrong And we could let them find the exit sign - with help from G-d."

Then, of course, he pulled the age card.  Why do they always pull the age card?

"You know, you are not young anymore," he reminded me.  "Your body just might not comply."

"Or," I countered, "my body may be so experienced from having three children all born at, or beyond their due date with little intervention and all in the 8-pound range, that it is in autopilot, just doing what it knows how to do best."

The doctor shrugged and completed his exam.  Everything was normal, thank G-d.

"See you next week," he said.

"Maybe I will and maybe I won't," I replied.

Induction Production

Here I sit hooked up to an IV and fetal monitors waiting for Pitocin to somehow squeeze these babies out of me.  You may be wondering how I ended up being induced after my rant about the doctor who asked me when I would like to be induced.

The short answer, is I take responsibility for my own healthcare decisions.  Given the proper information, I will make my own decisions, but being told that "we deliver twins at 38 weeks because that is what we do," is not giving me enough information to make choices.

After posting my blog on Babycenter.com's "Got Twins" forum, some of the other moms who had or are pregnant with twins expressed concern about my situation, citing studies that showed that identical twins, even in uncomplicated pregnancies, can have sudden high mortality rates after 37 weeks.  "Show me the study," was my jaded response.  Until one poster actually showed me, not one, but three studies citing serious problems with Mono-Chorionic/Di-Amniotic (i.e., identical) twins.  Another woman wrote, "As a mom who had a stillborn baby, I beg you to take this seriously.  You will never forgive yourself if something happens to your babies."

I studied the data.  It is surmised that it may be because identical twins typically share a placenta and after a certain point the placenta suddenly self destructs with no warning signs.  I called the High Risk doctor who monitors me and left a message asking about deteriorating placentas after the 37th week of pregnancy.  He did not call me back.

Instead, I got a call from my regular OB, who told me he just heard from the High Risk doc and began to quote me one of the studies that I already had in hand.  I thought about the studies and about the twins that I know so well.  If something happens to them, I would never forgive myself. And I read the studies over and over again.  

And then I told the doctor that I decided to be induced.

We negotiated a time and day - I didn't want a 7 am check-in at the hospital.  He was so glad I was "cooperating" that it didn't matter.

I told Bonnie, my doula, and sent her the studies.  She said they scared the "meconium" out of her.  But she sadly reminded me that my birth plan was about to be shot to oblivion.  The IV I had planned on not having, the fetal monitoring that was going to be intermittant only, the raspberry tea as I labored, and worst of all, playing the odds on the dreaded C-section -- were visions of the ideal birth that I had to (tearfully at first) kiss goodbye.

So as I gulped Homeopathic remedies and used Evening Primrose Oil to attempt to prime my body into action, and went one last time to my water aerobics class to try and shake my body, that had delivered three children at 40+ weeks each, into labor at a mere 37 weeks, I got used to the idea that I was going to check in to the hospital like I would a hotel, and have these babies in a not so natural way.

D packed everything but the kitchen sink, just in case our stay might result in a C-section.  He took umpteen changes of clothing, his new video camera, prayerbooks and Talmud texts, and he balanced Bonnie's birthing ball as he shuffled his way to labor and delivery.

So, here I sit, waiting for the Pitocin to kick in, as our babies nosedive around inside of me, hopefully looking for the exit sign.

Stay tuned...I will keep blogging and keep you informed.  From Providence Park Hospital in Novi, signing off for now.

No News is...No News...

I slept all night with the sound of baby heartbeats galloping like a cavalry racing to save the day.

As a new day dawned at Providence Park, I find myself still waiting for that elusive switch to be flicked so that labor can finally begin.  Pitocin contractions are wimpy - or else my body is just saying, "Ha!  You can't fool me!  This is NOT the real thing!"

"Please, make it hurt!" I begged the nurse.  "Turn up the Pit, please?"

"Are you for real?" she asked.

"You are the only woman in all my thirty years of experience to ask for pain," she said.  "Mostly women want epidurals."

I suppose the good news is, I'm not in pain.  The bad news is, as each hour flies by, the doctors look at their watches and wonder what else they can medically conjure up for the babies' coming out party, offering intrusive ideas like a medication that could cause a ruptured uterus, or breaking little Twin A's water sack and sticking an internal monitor in his head, a thought that makes me shudder.  And of course, the dreaded C-section option has come up again and again - even by my own husband.

The term "failure to progress" is one that shouldn't be applicable in my case.  After all, the artificial process has been started on a body that has an internal clock set at 40 weeks for singletons, not at 37 weeks for twins.  I am finding that artificially induced labor is not creating the peaks and valleys necessary for pushing babies out, so am I "in labor" or not?  Is this an age thing?  Has my uterus forgotten its moves?  Or is it just not ready?

So, for now, the doctors have given us some choices.  One is to continue increasing the Pitocin dose until we hit the maximum level, the other is the monster pill that could have heavy-duty side effects, another would be to break the water and hope that starts things seriously.  There is always a C-section.  Or we could go home for the weekend, come back on Sunday and start Pitocin all over again.  Personally, I like that idea, although it may just lead to revisiting this scenario three days later with he C-section Crusaders waiting outside my door.

Will I feel like a failure if I have a C-section?  There is a part of me that is anxious to meet our babies - and equally determined to minimize the risks associated with keeping them in longer than necessary.  If this "failure to progress" really is the function of an aging uterus and not simply the manifestation of an impatient team of doctors, then a C-section may ultimately be their only exit route.

Meanwhile, I am watching the fetal monitors and the upward swell of Pitocin drip - and praying that whatever happens, we make the right decisions.

The Dreaded C-Section

My apologies for keeping everyone hanging.  A lot has happened in the past ten days.  When I last blogged I was in early labor and things were progressing slowly.  At one point I was walking around, barely feeling the contractions, so I decided to jump, figuring, maybe the motion would shake the babies down.  A nurse came running into the room.  "What did you do?" she asked me, alarmed.  "I jumped," I explained.  She told me to stop immediately.  She saw on the monitor that Twin A was having "decelerations" - the heart rate dropping precipitously.  "Besides," she admonished, "a woman nine months pregnant with twins should NOT be jumping."

The Obstetrician explained that the decelerations could mean that the umbilical cord was compressed.  He said we would have to keep an eye on it.  Needless to say, I stopped jumping.

I checked into Labor and Delivery and the pitocin drip started on Wednesday.  Slowly, I began to lose track of time.  I called Bonnie, our Doula, and she came with Jenice, her apprentice on Thursday night.  She sat with me through the decision-making process.  Together with the doctor, my team decided to bring the pitocin  up to full speed, and rupture the membranes.  I was no longer begging for pain.  The contractions became unbearably strong and close together, although I still wasn't terribly dilated.  I labored in every position possible, the Doulas pushing on my back and on my knees, but the baby's decellerations continued.  Exhausted and wracked with pain that no deep breathing could ever alleviate, I begged the doctor for some relief and they started an epidural.  As the epidural was being administered, I was warned that if I didn't stay still, I could cause complications in my spine. Staying still while my body ached made my memories of passing a kidney stone seem like a walk in the park.

After the epidural was administered, I fell asleep while the doctors and nurses monitored my contractions.  When the doctor checked, as Thursday morphed into Friday, I was no further along and he was concerned because Baby A's heart rate kept fluctuating downward.  At around 5 am, he turned on the light and spoke to D and me about doing a C-section, the procedure I wanted to avoid at all costs.  But did I?  When I thought of my poor baby trying to unsuccessfully make its way down the birth canal and possibly being damaged by my recalcitrance, the choice became obvious.  And I appreciated being given the choice.

I said a small prayer in Hebrew that acknowledges that in the end G-d is in control of all medical situations and begs G-d to give the doctor the skills needed to successfully treat me.  I was keenly aware that this was surgery and there are serious risks and downsides to every surgical procedure, so after I connected with G-d I felt better.  I was wheeled into the operating room and prepped for the procedure.  An anesthesiologist and nurse stood by to switch my medication.  A gigantic drape separated me from the rest of the universe.  Bonnie, my Doula, sat next to me and held my hand.  D watched from afar.

I focused on trying to breath.  My body was shuddering.  Even though I didn't feel anything, I felt pressure and it was suffocating.  Then I heard a baby cry.  Baby A had been extracted, the umbilical chord wrapped around his neck - twice.  The OB went diving into me for Baby B but couldn't find his head.  He pulled him out by his bottom - a Cesarean breech delivery.  A second baby's cry joined the cacophony of wails.  Bonnie wiped my tears away.  Our baby boys were born safe and healthy. D clutched them to his scrubs and brought them over to me.  "They look just like the million ultrasounds," I said.  When they heard my voice, both babies stopped crying. 

"They know your voice," Bonnie smiled at me.

I thought about the dreaded C-section and the hours and hours of pitocin-induced labor.  It certainly wasn't what I would have chosen.  Did the induction keep my cervix from dilating?  Had I waited another week or two would the experience have been more natural?  Would Baby A have made it through a natural delivery.  No, it wasn't what I would have chosen, but ultimately, I'm convinced that I had very little control over the situation - and in the end, everything that happened was the way it had to be.

Our little miracles--our baby boys--were born on February 15 at 6:46 and 6:48 am at 5 lbs, 6 oz and 4 lbs 15 oz.

Blessings of the Bris

For a full week my babies had no names.  The Jewish tradition is to name a baby at their circumcision ceremony, called a Bris (or Brit), so Baby A and Baby B were the names we used.  Interestingly, I had no problem telling A from B - since they have been A and B in every ultrasound from the time we knew there were two of them.  A was the one who had been head first on my right side and B was the swimmer - the one who one minute was laying across of A's chest to obscure the Doppler heartbeat and scare the entire doctor's office, the next was head down, next to his brother.

I felt like I knew these little folks quite well by the time they emerged.  But I knew them as A and B, since we just hadn't decided on names.

Choosing a name was challenging.  We wanted Hebrew names that had withstood the test of time, in other words, that were familiar in the Jewish community.  A Jewish name has special significance.  While Jews of Sephardi origen name their babies for people who are living, Ashkenazi Jews use names of people who are deceased.  We were advised by our Rabbis to choose people who were sages, scholarly, and who espoused values that we wanted our children to have.  It is said that the spirit of the soul you are commemorating, infuses its way into the child bearing his or her name.  The responsibility of choosing those names weighed heavily upon us.

As the night before the brit arrived, D and I were still trying on names, intent on finding the right one.  The neighborhood children filed into the room where the one-week  babies lay asleep.  They clustered around the Pac n' Play and sang the "Shmah" prayer to the babies, sending them wishes of fortitude and hope on the eve before they entered the covenant of Abraham - the forefather who first performed Jewish circumcision on himself and later on his son Isaac at eight days old.  It was a very spiritual moment.  The children sang the blessings of Jacob to the babies, beseeching that the angels that accompanied that forefather, bless the boys in his name.

We didn't get much sleep that night.  We had a house full of company to take care of.  D was working on his speeches and the babies were more restless than they had been, probably tuning into the energy in the home.  The bris was scheduled for 7:45 am, but I knew from previous experiences to get to the synagogue early.  I stayed sequestered until the Mohel, the Rabbi who is trained in performing circumcisions, called for the babies - one at a time.

Friends of ours who are hoping for children were assigned the honor of "Kvatterer and Kvater" - bringing the babies in to the sanctuary.  Great Rabbis in the community were assigned honors that included holding and naming the babies.  There is a sanctity and purity about those few minutes before the bris, and everyone who comes in contact with the babies at that time issues a blessing and is subsequently blessed by simply coming in contact with the child.  It was important to both D and me to maintain the holiness of that spiritual connection.  At the bris ceremony, there were more blessings, over a cup of wine and by each person involved.  The circumcision surgery went quickly and the babies came back to me without any tears.

As for the names, recently, someone asked us why we named our children such "weird" names.  I guess to the uninitiated, it's hard to explain why, in a secular world, we would single our children out with strong Hebrew names - and no English name as a buffer.

We chose the names Shalom Heschel - named for my uncle, my father's brother, who passed away last year.  Uncle Solly, as we grew up calling him, was named Shalom because he was born just after peace was announced after World War I. He was a chemist in his secular life - a simple and quiet man who served in the U.S. armed forces and was one of the few who made it through the Battle of the Bulge.  But all that paled to the rest of his story.  A Torah scholar with a photographic memory for Hebrew studies , he later emigrated to Israel, and his legacy - his three children, numerous grandchildren and great grandchildren, all are beacons of Torah - every single one. 

Our second baby, Eliyahu Yehuda, was named for my great grandfather, a Torah scholar who received his Rabbinic appointment from the N'tziv, the head of a great Yeshiva in Velozhin, Lithuania.  I never met him, but family lore says he entertained some of the greatest Rabbis of the 19th century.  We have photographs of him hunched over his Talmud, learning Torah.

These are the people we hope our children will emulate some day--men who are no longer here, but who personified Jewish continuity.  Neither was wealthy, nor were they famous, but their Torah values live on in their children, grandchildren, and great-grandchildren as we hope those same values will in ours.